经口腔前庭腔镜技术治疗甲状腺恶性肿瘤的安全性与可行性探讨

An exploration of safety and feasibility of transoral vestibular endoscopy in the treatment of thyroid malignant tumors

目的:探讨经口腔前庭腔镜技术治疗甲状腺恶性肿瘤的安全性与可行性。方法:选取西安市中心医院2019年1月—2021年12月收治的120例甲状腺恶性肿瘤患者,随机分为腔镜手术组(60例)和传统开放手术组(60例)。比较2组患者手术一般情况、术后并发症及术后生存质量。结果:腔镜手术组患者术中失血量、留置引流管时间、平均住院时间显著低于传统开放手术组(P<0.05),而手术时间和淋巴结清扫数显著高于传统开放手术组(P<0.05)。2组患者术后24 h VAS评分、白细胞计数、TgAb(+)、暂时性甲状腺功能减退差异无统计学意义(P>0.05),而腔镜手术组C反应蛋白、总引流量、TgAb、血钙高于传统开放手术组,PTH、Tg低于传统开放手术组(P<0.05)。腔镜手术组患者术后发生声音嘶哑1例、手足麻木2例、皮下积液1例、颏神经损伤2例,并发症总发生率为10.00%,传统开放手术组患者术后发生声音嘶哑5例、手足麻木11例、饮水呛咳1例、术后出血1例、皮下积液4例,并发症总发生率为36.67%,腔镜手术组并发症总发生率低于传统开放手术组(P<0.05)。腔镜手术组患者生理状况、社会/家庭状况、情感状况、功能状况及生存质量总分均显著低于传统开放手术组(P<0.05)。结论:经口腔前庭腔镜技术治疗甲状腺恶性肿瘤手术情况和术后恢复较好,术后并发症较少,患者耐受情况良好,安全性值得肯定,具有较高的临床应用价值。

Objective:To investigate the safety and feasibility of transoral vestibular endoscopy in the treatment of patients with thyroid malignant tumors.Methods:120 patients with thyroid cancer admitted to Xi’an Central Hospital from January 2019 to December 2021 were selected and randomly divided into endoscopic surgery group(60 cases)and traditional open surgery group(60 cases).The general operation conditions,postoperative complications and postoperative quality of life were compared between the two groups.Results:The intraoperative blood loss,indwelling drainage tube time and average length of hospital stay in the endoscopic surgery group were significantly lower than those in the traditional open surgery group(P<0.05),while the operation time and number of lymph nodes dissected were significantly higher than those in the traditional open surgery group(P<0.05).There was no significant differences in VAS score at 24 h after surgery,white blood cell count,TgAb(+)and temporary hypothyroidism between the two groups at 24 h after operation(P>0.05).The CRP,total drainage volume,TgAb and serum calcium in the endoscopic surgery group were higher than those in the traditional open surgery group,and the PTH and Tg were lower than those in the traditional open surgery group(P<0.05).One case of hoarseness,2 cases of extremities numbness,1 case of subcutaneous effusion and 2 cases of chin nerve injury occurred in the endoscopic surgery group,the total incidence of postoperative complications was 10.00%.Five cases of hoarseness,11 cases of choking cough limbs numbness,1 case of drinking water,1 case of postoperative bleeding and 4 cases of subcutaneous effusion occurred in the traditional open surgery group,the total postoperative incidence of complications was 36.67%,the total incidence of complications in endoscopic surgery group was lower than that in traditional open surgery group(P<0.05).The total scores of physiological status,social/family status,emotional status,functional status and quality of life in endoscopic surgery group were significantly lower than those in traditional open surgery group(P<0.05).Conclusion:The application of oral vestibular endoscopy in the treatment of thyroid malignant tumors has the advantages of good surgical status and postoperative recovery,fewer postoperative complications.The patient was well tolerated,with positive safety,this technique has high clinical application value.